VHA Systems Redesign; Transformational change in health care ...

314 Health Care Management REVIEW
October–December 2007
Figure 1
Key elements of organizational transformation to deliver high-quality patient care
actively engage staff in meaningful problem solving; (4)
Alignment to achieve consistency of organization-wide
goals with resource allocation and actions at all levels of
the organization; and (5) Integration to bridge traditional
intra-organizational boundaries between individual
components.
In highlighting these factors, we run the risk of
presenting them as isolated and static. In reality, these
elements effect the transformation by driving change in
complex and dynamic health care organizations. As
illustrated inside the dotted circle in Figure 1, we define
the organization—or network of organizations comprising
the system—in terms of four basic components: (1)
Mission, vision, and strategies that set its direction and
priorities; (2) Culture that reflects its values and norms;
(3) Operational functions and processes that embody the
work that is done in patient care; and (4) Infrastructure
such as information technology, human resources, fiscal
services, and facilities management that support the
delivery of patient care. Changes in these four components
reflect the transforming health care system.
Transformation occurs over time, as illustrated by the
shadow boxes and diagonal line, leading to changes that
spread across the organization and are sustained.
We expand here on the five model elements and
their interactions, providing examples to illustrate each
element in practice and how it interacts with other parts
of the organization.
Key Drivers: Elements of the Model
Impetus to Transform
Each study system had a strong impetus to change. In
Figure 1, impetus appears outside the organization to
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